Note: Guidance is based on expert consensus. Subspecialty consultation for individualized recommendations for suspected cases is strongly recommended.
Figure 1. Diagnostic Pathway for MIS-C - PDF
Dermatologic: Take photo of rash/upload to Epic, Consider the following tests (HSV, VZV, enterovirus PCR); GI: Consider GI pathogen PCR panel; C difficile toxin PCR; Stool culture; Neurologic: Head imaging – consider if with focal neurologic deficit, altered mental status, seizure, severe headache with meningeal signs. If no contraindications, perform lumbar puncture (cell count, protein, glucose, culture, meningoencephalitis panel) AND CONSULT NEUROLOGY
Contributors: Charlotte Hobbs, MD (Peds ID), Anita Dhanrajani, MD (Peds Rheumatology), Catherine Gordon, MD (Peds Heme Onc), Robert Santos, MD (Peds ID), April Palmer, MD (Peds ID), Sue Phillips (Hospitalist), Linda Ray, MD, Charles Spencer, MD (Peds Rheumatology), Divya Shakti (Peds Cards), Jenny Hong (PICU).
LAST GUIDANCE UPDATE: MARCH 2021
Suggested readings and additional online resources for specialists caring for children with MIS-C:
American College of Rheumatology Clinical Guidance for Multisystem Inflammatory Syndrome in Children Associated With SARS–CoV‐2 and Hyperinflammation in Pediatric COVID‐19: Version 2. Arthritis Rheumatol. https://doi.org/10.1002/art.41616
The Children’s Hospital of Philadelphia (CHOP) clinical pathway for evaluation of possible MIS-C, Kawasaki pathway, suspected MIS-C with shock, and sepsis pathway: https://www.chop.edu/clinical-pathway/multisystem-inflammatory-syndrome-mis-c-clinical-pathway
Centers for Disease Control and Prevention. Multisystem Inflammatory Syndrome in Children (MIS-C) Associated with Coronavirus Disease 2019 (COVID-19). Available at: https://emergency.cdc.gov/han/2020/han00432.asp.
American Academy of Pediatrics, COVID-19 Interim Guidance: Return to Sports and Physical Activity. Available at: https://services.aap.org/en/pages/2019-novel-coronavirus-covid-19-infections/clinical-guidance/covid-19-interim-guidance-return-to-sports